Table 2. Unit Cost of Specialty Medications for Psoriasis and Psoriatic Arthritis.
| Medication | Unit, mg/mL | Point-of-sale price per fill, $, median (IQR) | Estimated patient out-of-pocket, $a | ||
|---|---|---|---|---|---|
| Cost first fill | After reaching catastrophic coverage | For 1 y of treatment | |||
| Etanercept | 50 | 5757.40 (5612.40-5953.60) | 1777 | 289 | 5714 |
| Adalimumab | 40 mg/0.8 mL | 5646.24 (5527.34-5834.82) | 1751 | 283 | 5653 |
| Golimumab | 50 mg/0.5 mL | 6006.27 (5784.87-6156.03) | 1822 | 298 | 5823 |
| Ustekinumab | 90 | 23 413.47 (22 853.74-24 236.98) | 3426 | 1175 | 6950b |
| Certolizumab pegol | 200 | 4631.20 (4538.83-4932.22) | 1536 | 240 | 5137 |
| Apremilast | 30 mg | 3609.6 (3511.20-3760.80) | 1234 | 181 | 4423 |
| Secukinumab | 150 | 5679.82 (5540.82-5818.50) | 1744 | 282 | 5635 |
| Abatacept | 125 | 4650.92 (4533.88-4860.72) | 1504 | 234 | 5059 |
| Ixekizumab | 80 | 5763.94 (5680.90-5986.31) | 1781 | 290 | 5725 |
| Brodalumab | 210 mg/1.5 mL | 5015.96 (4954.44-5206.88) | 1599 | 253 | 5288 |
| Tofacitinib | 5 mg | 4774.80 (4663.20-4935.00) | 1531 | 239 | 5125 |
| Tofacitinib XR | 11 mg | 4765.50 (4625.10-4932.60) | 1526 | 238 | 5113 |
| Guselkumab | 100 | 11 511.52 (11 222.97-11 626.23) | 2823 | 572 | 5686b |
| Tildrakizumab | 100 | 14 112.13 (13 937.43-14 643.84) | 2965 | 714 | 5107b |
| Risankizumab | 75 mg/0.83 mL | 16 248.90 (16 150.81-16 939.43) | 3076 | 825 | 5550b |
Abbreviation: IQR, interquartile range.
Estimated out-of-pocket costs were calculated for covered medications using the 2021 Medicare Part D standard benefit for brand-name drugs and the median per-fill price for each product. Patients filling non-covered drugs would pay the point-of-sale price for each fill. The 2021 standard benefit includes a $445 deductible, 25% coinsurance for drug spending in the initial coverage phase and coverage gap, and 5% coinsurance for drug spending in the catastrophic coverage phase. First fill and catastrophic coverage out-of-pocket costs are for a single fill and represent the highest (requiring patients to pay the deductible, 25% coinsurance for amounts covered in the initial phase and gap, and 5% in the catastrophic phase) and lowest (paying only 5% of the point-of-sale price) estimated out-of-pocket costs for each product. Annual out-of-pocket costs are for 12 monthly fills, unless otherwise indicated.
Annual out-of-pocket spending was calculated as 4 fills per year for ustekinumab, tildrakizumab, and risankizumab and as 6 fills per year for guselkumab. For all calculations, we assume no other medication fills in order to simplify presentation. Individuals using other medications would face higher total out-of-pocket spending than that shown.